Robotic and laparoscopic partial nephrectomy: a matched-pair comparison from a high-volume centre

Authors

  • Monish Aron,

    1. Center for Laparoscopic and Robotic Urology, Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
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  • Phillipe Koenig,

    1. Center for Laparoscopic and Robotic Urology, Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
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  • Jihad H. Kaouk,

    1. Center for Laparoscopic and Robotic Urology, Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
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  • Mike M. Nguyen,

    1. Center for Laparoscopic and Robotic Urology, Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
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  • Mihir M. Desai,

    1. Center for Laparoscopic and Robotic Urology, Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
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  • Inderbir S. Gill

    1. Center for Laparoscopic and Robotic Urology, Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
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Monish Aron, Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave/A100, Cleveland, OH 44195, USA.
e-mail: aronm@ccf.org

Abstract

OBJECTIVES

To evaluate the relative merits of robotically assisted partial nephrectomy (RPN), using a matched-pair analysis, with laparoscopic PN (LPN).

PATIENTS AND METHODS

Between July 2006 and August 2007, 12 patients had RPN for tumour; the outcomes were compared retrospectively with 12 matched patients who had LPN. Patients were matched for age, gender, body mass index, American Society of Anesthesiologists score, tumour side, size and location, and the specific technique used (early vs conventional unclamping). Operative measures evaluated included operative time, estimated blood loss, warm ischaemia time (WIT), and number of ports used. Outcomes measured included serum creatinine and estimated glomerular filtration rate before and after surgery, length of hospital stay, transfusion rate, operative and 30-day complication rate, and surgical margin status.

RESULTS

Overall there were no differences in perioperative variables (WIT, estimated blood loss, surgery time, length of stay) between the groups. Fewer ports were used during LPN. Renal functional outcomes, transfusion rate and complication rates were comparable. Two RPN cases required conversion to standard LPN. A subset analysis of six patients in each group who had early unclamping showed a 7-min shorter WIT with LPN (14 vs 21 min, P = 0.05), despite larger tumours being treated with LPN (3 vs 2.4 cm, P < 0.01) in this subset.

CONCLUSIONS

RPN is a developing procedure, and is technically feasible and safe, albeit with a longer warm WIT than LPN. Further experience is necessary to determine the relative merits of RPN.

Ancillary